The Doctor’s Opinion

Bart Ross, Recovery & Alumni Services Coordinator

Who was this doctor? His name was William Duncan Silkworth, M.D.(“Silky”).

Like much of the Alcoholics Anonymous history, exact dates are unclear. The research I’ve done had many discrepancies. He was born around 1879 and died in 1951. He was a graduate of Princeton University in 1896. He obtained his medical degree from New York University-Bellevue Medical School specializing in neurology, in 1899. He’s buried at the Glenwood Cemetery in West Long Branch, New Jersey.

During his internship at Bellevue, he discovered he had a passion for working with drunks and interned in the inebriate clinic. He was a member of the psychiatric staff in the U.S. Army Hospital in Plattsburgh, New York, from 1917-1919. Then he became an associate physician at the Neurological Institute of Presbyterian Hospital in NYC while also being connected with Broad Street Hospital from 1919 to 1929. He began working at Towns Hospital in NYC somewhere between 1924 and 1932. (I know that’s a big gap. The most likely correct year would be somewhere around 1929 and 1930 after being laid off from Presbyterian Hospital after the market crash of 1929.) While at Towns Hospital, he chose to continue to specialize in working with alcoholic and drug-dependent patients.

By 1939, he had treated tens of thousands of such patients. He had a different view on alcoholism based on what he had been witnessing through working with so many alcoholics. He argued that it’s a chronic medical illness with specific symptoms and no effective treatment, only a hopeless outcome. Until then, not much had been studied due to medical opinions that it was considered a vice and not an illness. Dr. Silkworth believed that there are different physical and mental reactions in alcoholics. He began to state they needed medical help to detox and restore their physical health. After detox, then a moral, psychological approach would produce an “essential psychic change.”

Bill W. was the first alcoholic to whom the doctor explained his allergy theory. He clearly stated that those who had developed this allergy could never use alcohol in any form at all. This was the first time in Bill’s W. life he heard that his alcoholism was not a lack of willpower or a moral defect but a legitimate illness.

Today, Dr. Silkworth’s opinion has been medically proven. When someone drinks alcohol, it sets off the release of endorphins, which are the brain chemicals that bind to some receptors in the brain, causing feelings of pleasure. The more you drink, the more endorphins are released that bind to the part of the brain with reward processing, further making the drinker intoxicated.

An alcoholics’ brain responds to alcohol by producing feelings of reward and pleasure, which cause the alcoholic to seek more and more regularly than people whose brains don’t work that way. This explains why most people say that they are losing control and that they had better stop (THESE WORDS NEVER LEFT MY LIPS), and the alcoholic feels like they’re gaining control. (Note: while writing this part of the article, I’m really missing Dr. B. He could have helped me explain the medical concept of the disease, and he would have loved doing so. R.I.P, my friend.)

Dr. Silkworth’s contributions to Alcoholics Anonymous and the addiction treatment field are tremendous. He allowed Bill W. and other members of AA to talk with the patients in Towns Hospital. In July 1938, he gave AA letters using the hospital’s letterhead (pg. xxv-xxxii).

(For some AA trivia, “The Doctor’s Opinion” began as page one in the 1st edition and was not changed to Roman numerals until the 2nd edition. I think it should still be page one.)

And most important, he saw the spiritual breakthrough in Bill W. and told him, “Something has happened to you I don’t understand. But you had better hang on to it. Anything is better than the way you were.” (Big Book, p.14).

He could have said you have lost your mind and prescribed medications. The encouragement of this man of science, as much as the spiritual experience itself, started AA on its way. Bill W. intuitively knew that this experience alone would not be sufficient to maintain his sobriety. He had the idea that he must help others who have the same problem, which became the core of AA and the reason for its success.

“PRACTICAL EXPERIENCE shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics. It works when other activities fail.” (Big Book, p.89)

Bill W. leaves Towns Hospital and begins attending Oxford Group meetings. He sought out alcoholics at Towns Hospital and Calvary Mission, trying to carry the message of hope that helped him. After five-six months of doing this, Bill W. was still the only one sober.

Bill W. had a conversation with Dr. Silkworth about his lack of success in helping other alcoholics. The doctor said to calm the religious approach down, stop preaching, and start by giving the medical facts first. This has proved to be the most important advice given to Bill W. for the success of getting the drunks to be interested.

In 1945, Knickerbocker Hospital in NYC was the first general hospital to have an award for the treatment of alcoholics. Alcoholics were admitted free of charge into this hospital under false diagnoses by their doctors so that they could be detoxed. Dr. Silkworth played a large part in making this possible.

Dr. Silkworth remained a friend of AA until his death on March 22, 1951. He took great pleasure in watching what was happening with alcoholics helping each other do something he had been unable to accomplish with his tremendous efforts.

Hanley Center is a well-known care provider offering a range of treatment programs targeting the recovery from substance use, mental health issues, and beyond. Our primary mission is to provide a clear path to a life of healing and restoration. We offer renowned clinical care and have the compassion and professional expertise to guide you toward lasting recovery.

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